Routine inspection·July 23, 2024

On 07/23/2024 at 09:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Mercillina Ajunwa arrived at the facility during the visit. At the time of the visit there were two (2) staff present, and two (two) residents present. The facility is a five (5) bedroom, three (three) bathroom home with a kitchen/dining area, living room/activity room and a garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility’s approved for three (3) hospice waiver. The current census is two (2) residents. LPA Brown was accompanied by Staff #3 (S3) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 118 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. However, LPA Brown observed bathroom screen window in disrepair. Technical Violation issued. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked. LPA Brown observed complete first aid kit and first aid book at the facility. Food Service : More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision : The facility has an Administrator present during the visit. However, LPA Brown observed no night shift staff scheduled to work at the facility as required for facility with dementia residents. Deficiency will be issued. Record Review : LPA Brown reviewed two (2) resident files for admission agreements, updated physician reports, and pre-placement appraisals. LPA Brown observed that Resident #2 (R2) Admission Agreement was not signed by both Licensee/Licensee Representative and Resident/Resident Representative. Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA Brown observed that Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) do not have cardiopulmonary resuscitation (CPR) training and first aid training. Deficiency will be issued. LPA Brown observed Staff #1 (S1) and Staff #2 (S2) do not have the required Health Screening Report in their file. Deficiency will be issued. LPA Brown observed Staff #1 (S1) and Staff #2 (S2) do not have Tuberculosis (TB) Test and TB Test result in their file. Deficiency will be issued. LPA Brown observed Staff #2 (S2) working at the facility but S2's criminal background clearance was not transferred to the facility prior to employment on 08/2022. Deficiency will be issued and Civil Penalties was assessed during the facility visit today with the amount of $500.00 for S2 will continue to be assessed of $100.00 per day per citation until corrected for not transferring S2 criminal record clearance prior to employment to the facility. Furthermore, Medications/Medication Administration Record (MAR) were audited, and LPA Brown observed that Staff #3 (S3) did not update Resident #2 (R2) MAR after dispensing R2's medication. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, LIC9102 TA Advisory Notes, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Mercillina Ajunwa.